Learn to improve your assessment, investigation, and management of physical health conditions in people with severe mental illness
The Maudsley Practice Guidelines for Physical Health Conditions in Psychiatry offers psychiatric and general practitioners an evidence-based and practical guide for the appropriate assessment, investigation, and management of common physical health conditions seen in people with severe mental illness. Written by a renowned team of respected experts in medicine, surgery, pharmacy, dietetics, physiotherapy, and psychiatry, the book bridges the gap between psychiatric and physical health services for the severely mentally ill.
The Maudsley Practice Guidelines for Physical Health Conditions in Psychiatry also provides practitioners with expert guidance on making effective referrals to other medical and surgical subspecialties, telling readers what information subspecialties would expect to receive. Its use will improve the quality of clinical care received by mentally ill patients and, by promoting a holistic approach to treatment that considers both body and mind, will enhance the therapeutic relationship between patient and practitioner.
The Maudsley Practice Guidelines for Physical Health Conditions in Psychiatry covers the following:
Guidance on assessment and management of well over a hundred different medical and surgical presentations commonly seen in people with serious mental illness Management of physical health emergencies in a psychiatric setting Evidence-based approaches to management of physical side effects of psychiatric medications Advice on approaches to promote a healthy lifestyle in people with serious mental illness, such as smoking cessation and changes to diet and physical activity
Perfect for both psychiatrists and general practitioners who wish to improve the quality of care they provide to people with serious mental illness, The Maudsley Practice Guidelines for Physical Health Conditions in Psychiatry will be of use to anyone setting out to navigate the divide between the treatment of psychiatric and physical health conditions.
Preface xxiii List of Abbreviations xxv Part 1 Cardiology 1 Chapter 1 Tachycardia 3 Guy Hindley, Eromona Whiskey, Nicholas Gall Sinus tachycardia 3 Atrial fibrillation 4 Supraventricular tachycardia 4 Ventricular tachycardia 6 Diagnostic principles 6 Management 10 References 14 Chapter 2 Bradycardia 17 Eleanor Croft, Nicholas Gall Diagnosis 19 Management and when to refer to a specialist 21 References 22 Chapter 3 QT Interval Prolongation 23 Guy Hindley, Nicholas Gall Prescribing QTc‐prolonging medication 27 Diagnostic principles 28 Management 29 References 32 Chapter 4 Syncope 35 Luke Vano, Nicholas Gall Causes of syncope 35 Syncope and serious mental illness 36 Diagnostic principles 36 Diagnosis and management 38 References 39 Chapter 5 Hypertension 41 Luke Vano, Toby Pillinger, J. Kennedy Cruickshank Diagnostic principles 43 Diagnosis 44 Management 45 References 48 Chapter 6 Postural Hypotension 51 Toby Pillinger, Ian Osborne, Thomas Ernst, J. Kennedy Cruickshank Diagnostic principles 53 Management 54 References 58 Chapter 7 Peripheral Oedema 59 Thomas Whitehurst, Theresa McDonagh Diagnostic principles 60 Management 66 References 67 Chapter 8 Myocarditis 71 Thomas Whitehurst, Theresa McDonagh Diagnostic principles 71 Management 75 Clozapine‐induced myocarditis 75 References 77 Chapter 9 Hypercholesterolaemia 79 Dipen Patel, Toby Pillinger, Narbeh Melikian Diagnostic principles 80 Diagnostic criteria 81 Management 81 References 84 Chapter 10 Physical Activity 85 Garcia Ashdown-Franks, Brendon Stubbs Physical activity and serious mental illness 85 How much physical activity and exercise should people be doing? 86 Practical tips 87 Messages to include in discussions with patients 87 References 88 Part 2 Endocrinology 91 Chapter 11 Diabetes Mellitus 93 Yuya Mizuno, Toby Pillinger, Dan Siskind, Sophie Harris Diagnostic principles 93 Management 97 References 102 Chapter 12 Thyroid Disease 105 Harriet Quigley, Jackie Gilbert Hypothyroidism 105 Diagnostic principles 107 Management 110 Hyperthyroidism 111 Diagnostic principles 112 Management 113 References 114 Chapter 13 Hyperprolactinaemia 117 John Lally, Toby Pillinger, Olubanke Dzahini, Sophie Harris Diagnostic principles 119 Management and when to refer to a specialist 121 Hyperprolactinaemia and osteoporosis risk in serious mental illness 122 Hyperprolactinaemia and cancer risk 123 References 123 Chapter 14 Obesity 125 Yuya Mizuno, Toby Pillinger, Dan Siskind, Ian Osborne, Kate Moffat, Donal O’Shea Monitoring 127 Prevention and treatment of weight gain 129 References 134 Part 3 Haematology 137 Chapter 15 Anaemia 139 Sanjena Mithra, Aleksander Mijovic Diagnostic principles 140 Management and referral pathways 143 References 145 Chapter 16 Neutropenia 147 John Lally, Toby Pillinger, Aleksander Mijovic Drug‐induced neutropenia and agranulocytosis 149 Diagnostic principles 150 Management 151 References 153 Chapter 17 Thrombocytopenia 155 Sanjena Mithra, Aleksander Mijovic Diagnostic principles 156 Management and when to refer 158 References 158 Chapter 18 Venous Thromboembolism and Anticoagulation 159 Helen Doolittle, Lara Roberts, Roopen Arya Risk factors 159 Prophylaxis 161 Diagnosis 162 Management 164 References 168 Part 4 Gastroenterology 169 Chapter 19 Gastro‐oesophageal Reflux and Peptic Ulcer Disease 171 Luke Vano, Seema Varma, John O’Donohue Gastro‐oesophageal reflux disease 171 Peptic ulcer disease 176 References 178 Chapter 20 Gastrointestinal Bleeding 181 Douglas Corrigall, David Dewar Diagnostic principles 183 Management 185 References 188 Chapter 21 Nausea and Vomiting 191 Mary Denholm, Matthew Cheetham Diagnostic principles 193 Management 195 References 198 Chapter 22 Dysphagia 199 Mary Denholm, Jason Dunn Causes of dysphagia in the general population 199 Diagnostic principles 200 Management 203 Oesophageal cancer in psychiatric populations 203 Dysphagia in the elderly 204 References 204 Chapter 23 Deranged Liver Function Tests 207 John Lally, Aisling Considine, Kosh Agarwal Diagnostic principles 207 Management 212 References 213 Chapter 24 Alcohol and Physical Health 215 Musa Sami, Joseph Cooney, Michael Heneghan What is harmful use? 215 Physical complications of alcohol use 216 Approach to the patient with suspected alcohol misuse 217 Management 220 References 222 Chapter 25 Unintentional Weight Loss 223 Mary Denholm, John O’Donohue Diagnostic principles 225 Management 227 References 227 Chapter 26 Dry Mouth 229 Enrico D’Ambrosio, Andrea Falsetti, Stephen Challacombe Diagnostic principles 231 Management 231 References 232 Chapter 27 Hypersalivation 235 Enrico D’Ambrosio, Andrea Falsetti, Toby Pillinger, Stephen Challacombe Diagnostic principles 235 Management 236 References 239 Chapter 28 Constipation 241 John Lally, Toby Pillinger, Kalliopi Vallianatou, Immo Weichert Diagnostic principles 243 Management 244 References 249 Part 5 Renal and Urology 251 Chapter 29 Urinary Retention 253 Atheeshaan Arumuham, Vimoshan Arumuham Urinary retention and serious mental illness 253 Diagnostic principles 254 Management 256 References 256 Chapter 30 Urinary Incontinence 259 Atheeshaan Arumuham, Vimoshan Arumuham Diagnostic principles 261 Management 262 References 264 Chapter 31 Polyuria 267 Atheeshaan Arumuham, Toby Pillinger, Benjamin Whitelaw Diagnostic principles 268 Management 269 References 271 Chapter 32 Sodium Derangement 273 Atheeshaan Arumuham, Peter Conlon Diagnostic principles 274 Management 276 References 277 Chapter 33 Potassium Derangement 279 Ellis Onwordi, Peter Conlon Hyperkalaemia 279 Hypokalaemia 282 References 285 Chapter 34 Chronic Kidney Disease 287 Ellis Onwordi, Toby Pillinger, Anne Connolly, Peter Conlon Diagnostic principles 289 Management 291 References 295 Part 6 Sexual and Reproductive Health 297 Chapter 35 Sexual Dysfunction 299 Rudiger Pittrof Assessment of a patient with sexual dysfunction 299 Management 301 References 304 Chapter 36 Contraception 307 Neha Pathak, Usha Kumar Clinical approach 308 Contraceptive options 308 Ethical and legal considerations 312 When to refer 313 Special considerations in patients with serious mental illness 313 References 314 Chapter 37 Infertility 317 Rudiger Pittrof Addressing infertility in psychiatric practice 317 Onward referral and further tests for infertility 318 Infertility treatments 318 References 318 Chapter 38 Sexually Transmitted Infection 319 Harriet Le Voir, Rudiger Pittrof History 319 STI testing in psychiatry 320 Determining urgency of clinical action/referral 321 Referral to sexual health services 322 References 324 Part 7 Infectious Diseases 325 Chapter 39 Pneumonia 327 Emma McGuire, Loren Bailey, Peter Saunders, Meera Chand Pneumonia and serious mental illness 329 Diagnostic principles 329 Management 332 References 335 Chapter 40 Influenza 337 Anna Riddell, Eithne MacMahon Diagnostic principles 338 Management 339 Preventing spread of influenza 341 References 342 Chapter 41 Urinary Tract Infection 343 Sian Cooper, Conor Maguire Urinary tract infection and serious mental illness 344 Diagnostic principles 344 Management 347 References 350 Chapter 42 Gastroenteritis 351 Maria Krutikov, Luke Snell Diagnostic principles 351 Management 354 References 356 Chapter 43 Viral Hepatitis 357 Klara Doherty, Aisling Considine, Kosh Agarwal Hepatitis B 357 Hepatitis C 361 References 364 Chapter 44 Tuberculosis 365 Sakib Rokadiya, Adrian R. Martineau Diagnostic principles 366 Management 369 References 371 Chapter 45 Human Immunodeficiency Virus 373 Rebecca Marcus, Jessica Gaddie, Toby Pillinger, Ben Spencer, Kalliopi Vallianatou, Rudiger Pittrof Testing for HIV 374 HIV and the central nervous system 374 Antiretroviral therapy 375 References 380 Part 8 Respiratory 383 Chapter 46 Smoking Cessation 385 Harriet Quigley, Mary Yates, John Moxham Identifying those who want to stop smoking and degree of nicotine dependence 385 Approaches to smoking cessation 387 References 392 Chapter 47 Chronic Obstructive Pulmonary Disease 395 Mary Docherty, Jenny Docherty, Peter Saunders Common causes of COPD in the general population and patients with serious mental illness 395 The asthma–COPD overlap 396 Diagnostic principles 397 Management 400 References 403 Chapter 48 Asthma 405 Mary Docherty, Jenny Docherty, Peter Saunders Causes in the general population and people with serious mental illness 405 Diagnostic principles 406 Management 409 References 412 Chapter 49 Obstructive Sleep Apnoea 413 Nicholas Meyer, Hugh Selsick, Kai Lee Diagnostic principles 414 Management 415 References 416 Part 9 Neurology 419 Chapter 50 Delirium 421 Luke Jelen, Sean Cross Diagnostic principles 421 Management 426 References 429 Chapter 51 Autoimmune Encephalitis 431 Adam Al-Diwani, Julia Thompson, Sarosh Irani Autoimmune disease mechanisms 431 Clinical approach 432 Management 437 References 439 Chapter 52 Catatonia 441 Jonathan P. Rogers, Ali Amad Diagnostic principles 442 Management 444 References 448 Chapter 53 Seizure Disorders 451 Emanuele F. Osimo, Brian Sweeney Acute seizure 452 Psychiatric comorbidity in people with epilepsy 455 Psychiatric side effects of antiepileptic drugs 457 Psychiatric drug therapy in people with epilepsy 457 Psychogenic non‐epileptic seizures 458 Epilepsy surgery 459 Epilepsy and learning disability 459 References 459 Chapter 54 Headache 461 Ines Carreira Figueiredo, Nazia Karsan, Peter Goadsby Diagnostic principles 463 Management 466 References 468 Chapter 55 Disorders of Sleep and Circadian Rhythm 471 Nicholas Meyer, Hugh Selsick Definitions of common sleep disorders in psychiatric populations 471 Diagnostic principles 474 Management 476 References 477 Chapter 56 Extrapyramidal Side Effects 479 Graham Blackman, R. John Dobbs, Sylvia Dobbs Clinical approach 480 Management 482 References 483 Chapter 57 Tardive Dyskinesia 485 Graham Blackman, Toby Pillinger, R. John Dobbs, Sylvia Dobbs Clinical approach 486 Management 487 References 489 Chapter 58 Tremor 491 Graham Blackman, R. John Dobbs, Sylvia Dobbs Clinical approach 491 Management 494 References 496 Part 10 Rheumatology and Musculoskeletal Health 497 Chapter 59 Low Back Pain 499 Jennifer Ireland, Matthew Cheetham Diagnostic principles 500 Management 502 References 503 Chapter 60 Arthritis 505 Sarah Griffin, Joseph Nathan, Richard Campbell Clinical approach 510 Management 512 References 512 Part 11 Ophthalmology 515 Chapter 61 Eye Disease 517 Ernest Iakovlev, Radwan Almousa Clinical approach to a patient with visual disturbance or orbital/periorbital disorders 517 Disorders of the eyelids 522 Disorders of the conjunctiva 526 Disorders of the cornea 529 References 533 Part 12 Obstetrics and Gynaecology 535 Chapter 62 Pregnancy 537 Katherine Beck, Ruth Cochrane, Louise M. Howard The pre‐conception period 538 During pregnancy 539 Psychiatric medication in pregnancy 543 Postpartum psychosis 547 Electroconvulsive therapy in pregnancy 547 References 548 Chapter 63 Menopause 551 Deirdre Lundy Physiology and symptoms of perimenopause 551 Clinical approach 552 Treatment 553 References 556 Part 13 Dermatology 559 Chapter 64 General Dermatology 561 Jonathan Kentley, Ruth Taylor, Anthony Bewley Infectious skin disease 561 Non‐infectious skin disease 564 References 566 Chapter 65 Psychodermatology 569 Jonathan Kentley, Ruth Taylor, Anthony Bewley Psychiatric disorders with skin manifestations 569 Psychophysiological conditions 571 Secondary psychological disorders 571 Cutaneous sensory disorders 572 References 572 Part 14 Electroconvulsive Therapy 573 Chapter 66 Electroconvulsive Therapy 575 James Kelly, Mariese Cooper, Mario Juruena Indications and contraindications 575 The ECT procedure 576 Physiological effects of ECT 576 Pre‐ECT assessment 578 Safety of ECT 579 ECT prescribing 579 Guidance for the doctor administering ECT 579 Side effects of ECT 580 Special patient groups 581 References 581 Part 15 Emergencies 583 Chapter 67 Chest Pain 585 Luke Vano, Immo Weichert Diagnostic principles 586 Management 590 Information to provide in a ‘chest pain’ referral to medical services 591 References 591 Chapter 68 Acute Shortness of Breath 593 Martin Osugo, Toby Pillinger, Vivek Srivastava Diagnostic principles 593 Management 595 References 596 Chapter 69 Acute Coronary Syndrome 597 Laura O’Sullivan, Narbeh Melikian Diagnostic principles 598 Management 602 References 603 Chapter 70 Arrhythmia 605 Martin Osugo, Nicholas Gall Tachycardia 605 Bradycardia 605 Reference 608 Chapter 71 Hypertensive Crisis 609 Luke Vano, J. Kennedy Cruickshank Diagnostic principles 609 Management 610 References 611 Chapter 72 Sepsis 613 Laura O’Sullivan, Immo Weichert When to think sepsis 613 Septic shock 614 Management 614 Post‐sepsis syndrome 615 References 616 Chapter 73 Acute Kidney Injury 617 Phillipa Brothwood, Toby Pillinger, Anne Connolly, Peter Conlon Categorisation of acute kidney injury 617 Diagnostic principles 620 Management 622 Psychiatric medication and acute kidney injury 622 References 623 Chapter 74 Diabetic Emergencies 625 Toby Pillinger, Yuya Mizuno, Sophie Harris Hypoglycaemia 625 Diabetic ketoacidosis 626 Hyperosmolar hyperglycaemic state 627 References 627 Chapter 75 Acute Upper Gastrointestinal Bleeding 629 Douglas Corrigall, David Dewar Signs of acute upper gastrointestinal bleeding 629 Waiting for transfer 629 Handing over to the acute medical team 630 Chapter 76 Status Epilepticus 631 Emanuele F. Osimo, Brian Sweeney Chapter 77 Anaphylaxis 633 James Kelly, Immo Weichert Management 633 References 636 Chapter 78 Reduced Consciousness and Coma 637 James Kelly, Immo Weichert Clinical approach 637 References 640 Chapter 79 Thyroid Emergencies 641 Harriet Quigley, Jackie Gilbert Hypothyroid crisis/myxoedema coma 641 Hyperthyroid crisis/thyroid storm 642 References 643 Chapter 80 Head Injury 645 Susie Bradwell, Sophie Williams, Joanna Manson Clinical approach 645 Types of intracranial haemorrhage 649 References 650 Chapter 81 Acute Meningitis and Infective Encephalitis 651 Hina Khan, Brian Sweeney Meningitis 651 Infective encephalitis 653 References 655 Chapter 82 Stroke and Transient Ischaemic Attack 657 Toby Pillinger, James Teo Stroke 657 Diagnostic principles 658 Management 659 Transient Ischaemic Attack 660 Diagnostic principles 660 Management 661 References 661 Chapter 83 Overdose 663 Stephen Kaar, Immo Weichert General principles 663 Information gathering 664 Emergency assessment and management 664 Specific scenarios 667 Management of a person who refuses admission to hospital after an overdose 670 References 670 Chapter 84 Acute Dystonia 673 Jonathan P. Rogers, R. John Dobbs, Sylvia Dobbs Diagnostic principles 673 Management 675 References 677 Chapter 85 Neuroleptic Malignant Syndrome 679 Robert A. McCutcheon, James Kelly, Toby Pillinger Diagnostic principles 679 Management 680 References 681 Chapter 86 Serotonin Syndrome 683 Robert A. McCutcheon, James Kelly, Toby Pillinger Diagnostic principles 683 Management 684 References 685 Chapter 87 Emergencies in Obstetrics and Gynaecology 687 Hanine Fourie, Ruth Cochrane Maternal collapse 689 Pre‐eclampsia 689 Major obstetric haemorrhage 691 Amniotic fluid embolism 691 Ectopic pregnancy 691 Miscarriage 693 Hyperemesis gravidarum 694 Ovarian cyst accidents 695 Pelvic inflammatory disease 697 References 697 Chapter 88 The Acute Abdomen 699 Sophie Williams, Joanna Manson History 699 Causes of the acute abdomen based on pain location 702 Examination 705 Investigations 706 Onward referral 706 References 707 Chapter 89 The ABCDE Approach 709 Toby Pillinger, Immo Weichert First steps 709 Airway (A) 711 Breathing (B) 711 Circulation (C) 711 Disability (D) 711 Exposure (E) 712 References 712 Index 713
David M. Taylor, BSc, MSc, PhD, FCMHP, FFRPS, FRPharmS, FRCP (Edin), is Director of Pharmacy and Pathology at the Maudsley Hospital; Professor of Psychopharmacology at King's College, London, UK. Fiona Gaughran, MD, FRCP(I), FRCP (Lon), FRCP (Edin), FRCPsych, FHEA, is Director of Research and Development at South London and Maudsley NHS Foundation Trust, where she is Lead Consultant for the National Psychosis Service; Reader in Psychopharmacology and Physical Health at King's College, London, UK. Toby Pillinger, MA (Oxon), BM BCh, MRCP, PhD, is an Academic Clinical fellow at the Institute of Psychiatry, Psychology and Neuroscience, King's College, London; South London and Maudsley NHS Foundation Trust, London, UK.
